Healthy People, Healthy Planet

Climate Change and Chronic Disease:

Common Drivers, Common Solutions
Module 1: Climate Change
Module 2: Chronic Disease
Module 3: Common Drivers,
Common Solutions
Presented by:
Jill Stein, MD
Greater Boston Physicians for Social Responsibility
With Support from:
The Boston University Superfund Research Project

Healthy People, Healthy Planet:

Objectives

To inform & empower health

providers to understand, mitigate
& help prevent climate change &
chronic disease.

Review key science behind

climate change and chronic
disease.

Clarify the major drivers of these

crises and how we can fix them.

Healthy People, Healthy Planet

Climate Change and Chronic Disease:
Common Drivers, Common Solutions
Chronic Disease
Module 2 of 3

Jill Stein, MD
Greater Boston
Physicians for Social
Responsibility

Module 1: Climate Change Review

Climate change is already causing devastating

human impacts, and it is accelerating.

CO2, temperature, ice, and sea levels are

linked. High CO2 is melting ice sheets
worldwide, posing risks of catastrophic sea
level rise if allowed to persist.

Over 300,000 lives per year are lost from

extreme weather, famine, floods, declining air
quality, and spreading tropical diseases.
Greatest impacts are in poor countries.

To reverse these impacts and prevent far worse

ones already in the pipeline, CO2 must be
brought to a safe level below 350 ppm
urgently.

Module 2: What We Will Cover

Environmental factors are key drivers of many

common chronic diseases.

Environmental factors alter key biological

pathways leading to chronic disease.

Scope of the Problem

A

century of change in natural, built and social

environments has caused dramatic changes in the patterns
and distribution of diseases.

Since

the beginning of the 20th century more children are

developing chronic diseases.

The

over-65 population will nearly double by 2030 to more

than 71 million, sharply increasing the number of people at
risk of chronic diseases of aging like Alzheimers and
Parkinsons diseases, among others.

We

are seeing dramatic increases in chronic diseases such

as diabetes that are themselves risk factors for dementia.

Lifetime

environmental factors play a key role in health.

The Changing Environment and

Disease Patterns

During the past century, human activity has altered

virtually all aspects of the worlds ecosystems:

Pervasive spread of synthetic chemicals; air and water pollution.

Industrialized food supply.
Destruction of critical natural habitats, stressing ecosystems.
Climate change.

How we live, eat, work, play, socialize affects health:

Built environments have increased social isolation for many

people; reduced physical activity.
Growing income gap increases disease risk.
Diseases of civilization - obesity, diabetes,
cardiovascular disease, hypertension.

Alzheimers Disease/dementia

Disabling impairment of memory and executive

function, usually accompanied by other cognitive
and motor deficits.

Expected to triple by mid-century to

over 13 million.

Likely caused by varying

combinations of genetic and
environmental factors.

Not an inevitable feature of normal aging.

Annual costs in US over $150 billion.

Parkinsons Disease

Progressive movement disorder that includes

combinations of tremors, stiffness, emotional
changes leading to severe disability.

Likely caused by variable combinations of

genetic and environmental factors.

About 50,000 new cases annually in US.*

Prevalence in US expected to double by 2030.*

* Due to the lack of registries and baseline data on Parkinsons Disease, the
figures used here are estimates.

Alzheimers and Parkinsons

Diseases

Characterized by:
-

abnormal protein deposits

chronic inflammation
abnormal oxidative stress

Many neuroscientists are beginning to think

of some neurodegenerative diseases along a
continuum, often without clearly distinct
boundaries or clinical or pathological
manifestations

Continuum of Age-Associated
Cognitive Impairment

Environment Drives Chronic Disease

Environmental
Factors
Food system/Diet
Fossil Fuels
Socioeconomics/Stress
Chemicals
Built Environment/
Transportation

Altered
Pathways
Inflammation
Disrupted Insulin Signaling
Oxidative Stress

Parkinsons

Western
Disease
Cluster
Diabetes
Obesity
Abnormal Lipids
Metabolic Syndrome
Cardiovascular
Disease

Alzheimers

Profound Public Health Impact

Of The Western Disease Cluster

Obesity/overweight 2/3 US adults, prevalence X2 in

recent decades

Pre/Diabetes 40% US adults. Prevalence DM ~X2

over 20 yrs
Cowie 09 CDC. http://apps.nccd.cdc.gov/DDTSTRS/default.aspx

Cardiovascular disease still leading cause of death.

Hypertension increasing.

Metabolic syndrome = early signs of other cluster

diseases; 35% adults, ~55%>60 yrs
Ford ES 05

Alzheimers disease >84 yrs old, 5.3M

Basic Principles

Early life experiences can influence later-life health

and disease.

Multiple factors interact to influence health & disease.

An ecological health framework considers the individual

in the context of family, community, society and
ecosystem.

Environmental factors can alter natural pathways which

in turn can lead to chronic disease.

Early life experiences can influence later-life health, disease.

Toxic exposures
Oxidative stress

Obesity, Hypertension,
Cardiovascular Disease,
Diabetes

Low
Birth
Weight

Aging Begins At Conception

Alzheimers,
dementia,
Parkinsons

Multiple factors
interact to
influence health
& disease
i l t en
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diseas

Environmental Threats to Healthy Aging. J.

Stein, T. Schettler, B. Rohrer, M. Valenti,
Greater Boston Physicians for Social
Responsibility 2008.

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An ecological health framework considers

the individual in the context of family,
community, society and ecosystem.

Environment Drives Chronic Disease

Environmental
Factors

Altered
Pathways
Inflammation
Disrupted Insulin Signaling
Oxidative Stress

Mechanism
of Action

Western
Disease
Cluster

Classical Concept
of Inflammation

The New Concept of

Inflammation

Defined by appearance.
Calor, dolor, rubor,
tumor.
Heat, pain, redness,
swelling.
Atherosclerosis is an
inflammatory disease.
- Ross, Russell. Atherosclerosis
An Inflammatory Disease. New
England Journal of Medicine 340(2);
115-126. 1/14/99
http://pathmicro.med.sc.edu/ghaffar/innate.htm

Oxidative Stress
INTERNAL
+

ROS
Superoxide
Hydrogen peroxide
Etc.

Tissue Injury
Mitochondria
Leukocytes

Antioxidants
+

EXTERNAL
Tobacco smoke
Industrial pollutants
Ozone, particulates
Pesticides
Radiation
Anesthetics
Organic solvents
Some pharmaceuticals
High oxygen

Insulin Signaling =
Normal Metabolism
Insulin
signaling

blood sugar
artery disease
triglycerides

Disrupted Insulin Signaling =

Inflammatory Metabolism

Omega-3
(Omega-6)

Inflammation

Oxidative
stress

Insulin
signaling

blood sugar
artery disease
triglycerides

Summary

During the past century, human activity has altered

virtually all aspects of the worlds ecosystems, and
changed important determinants of human health.

Environmental factors drive the Western disease

cluster, a group of illnesses that cluster within
western societies and within individuals.

These environmentally-driven illnesses are major

components of the modern public health burden.

The mechanisms linking environmental drivers with

disease outcomes include inflammation, oxidative
stress, and disrupted insulin signaling.

Module 3: Common Drivers, Common Solutions

Environmental factors are major determinants of health.

They include:
Food system/nutrition and diet
Toxic chemicals
Built environment / physical activity
Socioeconomic stress

A variety of cross cutting

solutions dramatically improve
human and ecological health.

Acknowledgements

Based on the Report by Greater Boston Physicians for

Social Responsibility (www.psr.org/boston) and the
Science and Environmental Health Network
(www.sehn.org) authored by Jill Stein MD, Ted Schettler
MD, MPH, Maria Valenti & Ben Rohrer
Primary author of this presentation: Jill Stein, MD
Contributing Authors: Ted Schettler, MD, MPH, Maria
Valenti, Maye Thompson, RN, PhD, Marybeth
Palmigiano, MPH
Illustrations by: Stephen Burdick Design

For more information contact:

Greater Boston
Physicians for Social Responsibility
www.psr.org/boston
For additional resources on
environmental health and nursing contact:
The Environmental Health Nursing
Education Collaborative
www.ehnursing.org